If your partner has a hormonal imbalance linked to a low sperm count, or poor sperm quality or motility, he may be offered gonadotrophins (NCCWCH 2004: 52; 59-60).

Talk to your doctor about your chances of success using these drugs. If you’re paying for your treatment, be clear about how much these drugs will cost. This way you can weigh up the pros and cons as best you can before beginning treatment.

How do gonadotrophins work?

The two hormones your body produces that are crucial for ovulation to take place are luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Gonadotrophins are injectable forms of these hormones. They directly stimulate your ovaries to produce and ripen eggs.

The type of gonadotrophins that have been in use for the longest time contain both FSH and LH. These are called human menopausal gonadotrophins (hMG).

Some drugs now contain only purified FSH. They achieve the same results (NCCWCH 2004: 62) but cause fewer side-effects (Nugent et al 2000). These are called follitropins.

You’ll have gonadotrophins in conjunction with another hormone called human chorionic gonadotrophin (hCG). HCG triggers the release of the mature eggs (HFEA 2009).

How long will I need to be treated with gonadotrophins?

You can begin treatment any time when you’re not ovulating. Your course of injections will continue daily for seven days to 12 days each month, depending on how long it takes for your eggs to mature.

Your doctor might teach you how to give yourself the injections so you don’t have to travel to the clinic every day. You may want your doctor to show your partner how to do the injections, if you don’t want to do it yourself.

While you’re having the injections, your doctor will monitor you to see when you’re likely to ovulate. This means you’ll have frequent ultrasounds to check your ovaries. The ultrasounds will be carried out using a probe inserted into your vagina and shouldn’t cause you too much discomfort. You may need to have blood tests to check the levels of your hormones too.

When the ultrasound shows that your eggs are mature, you’ll be given an injection of hCG to trigger ovulation. Ovulation usually occurs between 24 hours and 36 hours after the hCG injection.

You and your partner will need to time sex soon after your injection. If you’re having IUI, your partner’s sperm sample will be injected into your uterus (womb). If you’re having IVF, the egg collection procedure will be scheduled for about 36 hours after your injection.

You’re likely to have a maximum of three to six drug cycles. Success rates don’t improve if you take the drugs for a longer time. If you try three times or more and don’t get pregnant, your doctor may increase the dose or suggest another kind of treatment.

Do gonadotrophins have any side-effects?

It’s possible that you may experience any of the following symptoms:

an allergic reaction to the drug

upset tummy

headache

joint pain

fever

soreness or reaction at the injection site

(BNF 2011)

You may find that giving yourself an injection directly into your muscle, probably your thigh, is difficult as it requires a long needle. The newer, purer gonadotrophins cause fewer side-effects and can be injected using smaller needles under your skin.

Taking these fertility drugs can be an emotionally intense process. As well as all the injections, you’ll need to have frequent monitoring.

There’s a risk with treatment involving gonadotrophins, and hCG in particular, of developing ovarian hyperstimulation syndrome (OHSS) (Balen 2008). This is when your ovaries rapidly swell to several times their usual size. Your ovaries may also leak fluid into your abdominal cavity.

Most cases of OHSS are mild. They result in:

bloating

mild abdominal pain

nausea

(RCOG 2007)

Severe OHSS is signalled by:

sudden, severe pain in your belly

vomiting

thirst and other symptoms of dehydration

(RCOG 2007)

If a scan shows that your ovaries are developing too many eggs, you’ll be advised not to have sex or exercise strenuously. This is to avoid the risk of injury to your swollen ovaries (RCOG 2006: 4).

If you’re trying to get pregnant without additional fertility treatments, it can be disappointing to have to abandon a cycle of treatment. It’s worth being cautious, though, as you also risk having a multiple pregnancy. This can lead to complications for you and your babies.

What else should I know about gonadotrophins?

You’ll want to think carefully about the risks before embarking on these treatments. Even with the best monitoring, OHSS can happen. About a third of IVF cycles are affected by mild OHSS. Between three per cent and eight per cent of cycles are affected by moderate or severe OHSS (RCOG 2006: 2).

If you have PCOS, you have a one in three chance of a multiple pregnancy after taking fertility drugs such as gonadotrophins (NCCWCH 2004: 67).

Fertility drugs such as hMG don’t seem to significantly increase your risk of developing ovarian cancer, even if you take them for more than a year (Brinton 2007, Cetin et al 2008). This was previously a concern. However, it’s now thought that the underlying causes of fertility problems (such as endometriosis) could be a risk factor, rather than the drugs used to treat them.

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